What is accident cover and how does it work?

By Hayden Wilson

3 minutes

26 June 2020

Woman holding up phone

If you had a crystal ball that predicted every mishap and accident before it happened – and maybe the winning lottery numbers – you might not need health insurance to cover you for accidents.

But life doesn't always work out that way, and health insurance can play an important role in protecting your number one asset in life - your health. If you are young and healthy, you might not need a Gold Hospital policy, but it could still make a lot of sense to have cover for accidents.

What is accident cover?

Basically, accident cover allows you to avoid public hospital waiting lists and see the doctor of your choice at a private hospital if you require hospitalisation after an accident. At HBF, accident cover is included on our Basic Hospital Plus cover and our Basic Hospital Plus Elevate cover.

HBF defines an accident as:

An unforeseen event, occurring by chance and caused by an external force or object which results in an injury to the body requiring admission to Hospital for medical treatment.

In layman’s terms an accident could be falling off your bike, getting tackled during a footy match, or slipping on water and you need to be hospitalised to treat the injury.

Just for clarity, any illness or condition that develops over time, like heart disease, would not be considered an accident.

If I have an accident, what is covered?

If you have HBF's Basic Hospital Plus or Basic Hospital Plus Elevate cover and have an accident that requires you to be admitted into hospital, you’ll be covered for the treatments you need.

This is powerful. Regardless of the standard waiting periods and service exclusions on your cover, you’re protected. For example, if you need knee replacement surgery after an accident, you’d be covered for it – even though it’s normally only included on higher levels of cover.

This also means you can choose a private hospital for your treatment. You’ll potentially avoid a long public hospital waiting list and enjoy all the perks of private hospital treatment.

Here is what HBF members are entitled to for agreed services at a Member Plus hospital:

  • Cover for your own private room1
  • Fully covered for theatre fees
  • Prostheses
  • In-hospital pharmacy
  • Covered for hospital boarders

Normal rules for medicals gaps apply (see your policy documents for more details or call us on 133 423.

When can I use accident cover?

As long as your premium payments are current, you see a Medical Practitioner within seven days of your accident, and you’re admitted to hospital within 90 days of your initial appointment, we may pay benefits under your accident cover.

If you have an accident, here are the things that will need to be ticked off the list before we can get started on your claim.

  • Waiting periods
  • You don't have to wait for long to claim accident cover on Basic Hospital Plus or Basic Hospital Plus Elevate. There is a one-day waiting period, which means you can't claim on the same day you take out the cover, but if you have an accident the next day, you're all good.

  • Current cover
  • You will also need to make sure your premium payments are up to date on the day of your treatment, which means your policy cannot be in arrears.

  • Initial medical presentation within seven days
  • You must be seen by a Medical Practictioner or admitted to hospital for medical treatment within seven days of the accident.

  • Admission to hospital for treatment within 90 days

If your doctor says you need hospital treatment (as an admitted patient) as a result of the accident, you must be admitted to a hospital within 90 days of your initial medical presentation after the accident.

When can't I use accident cover?

There are a few scenarios where benefits may not be payable, for example, if your premium payments are not up to date when you get treatment, or if the accident occurred as a consequence of your employment.

Remember to always check in with your health fund before you receive any treatment to confirm what you’re covered for.

Is accident cover right for me?

If you're looking for entry-level hospital cover that provides you with accident cover, Basic Hospital Plus offers just that. If you’re looking for a step up, you can consider Basic Hospital Plus Elevate which also has accident cover.

But before you decide on cover, make sure you consider your needs – not just the price tag. The best value cover for you is the one that caters to your specific needs.

If you're thinking about planning a family, need some peace of mind or have a few health concerns, we strongly recommend you chat with our friendly team to find the right cover for you.

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1 Subject to availability.